New studies reveal childhood vaccine costs are variable in private sector

ANN ARBOR, Mich. The high cost of some childhood vaccines is putting a significant financial strain on some physicians, according to research from the University of Michigan Health System. However, that burden could equate to an increase in business for retail-based clinics as some physicians may eventually opt to no longer provide all vaccines or may delay the purchase of some vaccines for financial reasons.

A pair of new studies from the University of Michigan Health System found that many physicians appear to be paying too much and receiving too little reimbursement for childhood vaccines.

The survey is of 1,280 U.S. pediatricians and family physicians engaged in direct patient care. Of the pediatricians, 70 percent responded, along with 60 percent of family physicians. They study of costs and reimbursements included data from 76 practices.

With vaccines for children enrolled in Medicaid funded by the public sector through the federal Vaccines for Children Program, prices are negotiated annually with vaccine manufacturers by the Centers for Disease Control and Prevention. But the data from the new studies support the belief that costs and reimbursements are widely variable in private practices.

“Until now, nobody knew what anyone was paying,” stated lead author Gary L. Freed, M.D., MPH, chief of the division of general pediatrics and director of the Child Health Evaluation and Research Unit at the U-M Health System’s Mott Children’s Hospital. “This information will change the way in which physicians negotiate prices.” The studies appear in the December issue of the journal Pediatrics.

The studies found that the price-per-dose of one brand of hepatitis B vaccine, for example, ranged from $4.26 to $13.06 at different medical practices. Reimbursements of the MMR (measles, mumps and rubella) vaccine ranged from $16.77 to $59.02. Many physicians in the survey expressed dissatisfaction with the price and reimbursement levels of vaccines.

While few physicians in the survey indicated that they had considered no longer providing all vaccines to privately insured children (11 percent overall; 5 percent of pediatricians and 21 percent of family physicians), about half of them reported that they had delayed the purchase of some vaccines for financial reasons and experienced a decline in profit margins from immunizations.